Path analysis of the impact of prenatal alcohol on adult vascular function
Path analysis of the impact of prenatal alcohol on adult vascular function
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DOI：
10.1111/acer.14970
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发表时间：
2022-11-16
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影响因子：
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通讯作者：
Coles, Claire D.
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作者：
Kable, Julie A.;Mehta, Puja K.;Coles, Claire D.
血管系统可能特别容易受到产前酒精暴露（PAE）的影响。血管生成的改变和血管发育的表观遗传改变可能是这种易感性的机制。方法：我们评估了产前酒精暴露（PAE）对成人血管健康的长期影响，采用在子宫内首次确定的前瞻性队列。无PAE的参与者（n = 37，平均年龄= 36.7 [SD = 1.6]岁）与有PAE的参与者（n = 51，平均年龄= 36.3 [SD = 1.7]岁）进行比较。他们的血管健康是通过动脉血压（BP）和外周动脉血压计来评估的，这产生了内皮功能指数（反应性充血指数）和动脉硬度指标（增强指数）。采集血液样本以评估胆固醇水平和胰岛素抵抗（葡萄糖、糖化血红蛋白和胰岛素）。在调整了其他已知的身体结果后，使用通径分析来检查PAE对血管健康的直接和间接影响。结果有PAE病史的参与者比没有PAE病史的参与者体重更轻，趋向于更矮，体重更小，并且有更多与酒精相关的畸形特征。通径分析表明，PAE对BP的影响是通过其与身高、体重指数和畸形特征的间接关系产生的，相对于超重不成比例的对照组，PAE对BP具有保护作用。研究还发现PAE对内皮功能有直接的负面影响。总酒精相关的畸形特征指数是负的，对动脉硬度有直接影响，对内皮功能有间接影响。结论产前酒精暴露对血管功能的影响并不独立于其他常见的生理和环境因素，但在控制了这些因素后，内皮功能和动脉僵硬度受到的影响最大。酒精相关的畸形特征水平似乎比内皮功能和血管僵硬更能预测不良反应。
Background The vascular system may be particularly vulnerable to prenatal alcohol exposure (PAE). Alterations in angiogenesis and epigenetic changes to vascular development have been implicated as a probable mechanism for this vulnerability. Methods We assessed the long-term impact of prenatal alcohol exposure (PAE) on adult vascular health using a prospective cohort first identified while in utero. Participants with no PAE (n = 37, mean age = 36.7 [SD = 1.6] years) were compared to participants with PAE (n = 51, mean age = 36.3 [SD = 1.7] years). Their vascular health was assessed by arterial blood pressure (BP) and peripheral arterial tonometry, which yields an index of endothelial function (reactive hyperemia index) and a measure of arterial stiffness (augmentation index). Blood samples were collected to assess cholesterol levels and insulin resistance (glucose, hemoglobin A1C, and insulin). Path analysis was used to examine the direct and indirect effects of PAE on vascular health after adjusting for other known physical outcomes. Results Participants with a history of PAE weighed less, trended towards being shorter, had smaller body mass, and had more alcohol-related dysmorphic features than those without PAE. Path analysis suggested that the impact of PAE on BP was through its indirect relationships with height, body mass index, and dysmorphic features and resulted in protective effects relative to the Contrast group who were disproportionately overweight. PAE was also found to have a direct negative effect on endothelial function. An index of total alcohol-related dysmorphic features was negatively had both a direct effect on arterial stiffness and an indirect effect on endothelial function. Conclusions Prenatal alcohol exposures' impact on vascular function is not independent of other common physical and environmental factors but endothelial function and arterial stiffness seemed most compromised after controlling for these other factors. Level of alcohol-related dysmorphic features seems to be predictive of more adverse effects than endothelial function and vascular stiffness.